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Today, I am pleased to announce that with our Japanese partners we are releasing a synthesis of case study findings from 11 countries that have achieved, or are committed to achieving, universal health coverage.
今天，我很高興地宣布，我們同日本合作伙伴共同發布了已經實現或者致力于實現全面健康覆蓋的11個國家案例的綜合研究成果。
These 11 countries are diverse – geographically, culturally, and economically. But all of these countries are demonstrating how these programs can improve the health and welfare of their citizens and promote inclusive and sustainable economic growth.
這11個國家在地理上、文化上和經濟上千差萬別。但所有這些國家都顯示出這些計劃如何能夠改善國民的健康與福祉，并促進包容性和可持續的經濟增長。
The good news is that many low- and middle-income countries are introducing fundamental reforms and achieving remarkable progress.
好消息是，許多低收入國家和中等收入國家正在出臺根本性的改革，并取得了顯著進展。
So what are the main lessons from these 11 countries? Here are five:
那么，這11個國家的重要經驗啟示是什么呢？一共有五條：
One, strong national and local political leadership and long-term commitment are required to achieve and sustain universal health coverage;
第一，強有力的國家和地方政治領導力和長期的承諾是實現和維持全民健康覆蓋的必要條件；
Two, short-term wins are critical to secure public support for reforms as in the case of Turkey where hospitals were outlawed from retaining patients unable to pay for care;
第二，短期成功對于獲得公眾對改革的支持具有關鍵意義，比如土耳其對不讓付不起醫療費的患者離開的醫院予以取締；
Three, economic growth, by itself, is insufficient to ensure equitable coverage—so countries must enact policies that redistribute resources and reduce disparities in access to affordable, quality care;
第三，經濟增長本身不足以確保公平覆蓋，所以各國必須頒布政策重新分配資源和縮小在獲得可負擔的優質醫療保健服務方面的差距；
Four, strengthening the quality and availability of health services depends not only on highly skilled professionals but also on community and mid-level workers who constitute the backbone of primary health care.
第四，加強衛生保健服務的質量與可獲性不僅取決于技術高超的專業人員，還取決于構成初級衛生保健骨干力量的社區和中層工作者；
And finally, five, countries need to invest in a robust and resilient primary care system to improve access and manage health care costs.
第五，國家需要投資建立一個強大堅韌的初級衛生保健體系，以改善醫療保健服務獲取和管理醫療衛生費用。
Not surprisingly, all of these cases also demonstrate that as countries move toward universal coverage, they will confront competing demands and continuing trade-offs. Countries face choices that can either enhance or erode coverage. The countries which have been most successful in expanding coverage have been in a mode of continuous learning – from what is happening both inside and outside their borders – and adapting their approaches based on the best available knowledge and evidence.
毫不奇怪，所有這些案例也表明，隨著全民健康覆蓋的進程，國家將會面臨相互競爭的需求，需要不斷做出權衡取舍。國家面臨在增強或削弱健康覆蓋兩者之間做出抉擇。在擴大健康覆蓋方面最成功的國家始終處于一種不斷學習的模式——借鑒國內外的發展經驗，并根據可獲得的最佳知識與實證不斷調整他們的模式。
A promising message from these case studies is that even low-income countries with low levels of health coverage can still aim for universal health coverage. Countries can start by building their institutional capacity, learn from the experiences of other countries, and adapt innovative approaches that can catalyze the expansion of coverage.
從這些案例研究中產生的一個令人鼓舞的信息是，即使健康覆蓋水平偏低的低收入國家仍可以全民健康覆蓋為目標。國家可以從自身的機構能力建設出發，借鑒別國的經驗，采取創新方式促進覆蓋面的擴大。
These are the cross-cutting lessons. Now let’s take a closer look at a few of these countries:
這些都是跨領域的經驗啟示。現在我們來仔細看看其中幾個國家的案例：
In Turkey, an economic crisis in the early 2000s prompted major government reforms and laid the groundwork for the 2003 Turkey Health Transformation Program. Turkey cleaned up government deficits and created leaner and more efficient state bureaucracies—and also opened doors for reform in the health sector by breaking old interest group politics. Outcomes are impressive: Today, more than 95 percent of the Turkish population is covered by formal health insurance. The Program now provides a high level of financial protection and equity while ensuring high and rising levels of patient satisfaction. Furthermore, infant mortality rates have declined from 28.5 per 1,000 live births in 2003 to 10.1 per 1,000 live births in 2010, and the maternal mortality ratio fell from 61 deaths per 100,000 live births in 2000 to 16.4 deaths per 100,000 live births in 2010. Turkey’s example proves that financial constraints—even a major financial crisis—can catalyze the expansion of coverage. The Bank Group has been pleased to partner with the Turkish government to support this effort.
在土耳其，21世紀初爆發的經濟危機促使政府進行了重大改革，為2003年土耳其的衛生改革計劃奠定了基礎。土耳其清理了政府赤字，建立了更加精簡高效的政府機構，同時也破除了老的利益集團政治，敞開了衛生部門的改革大門。其結果令人印象深刻：如今，正規醫療保險覆蓋面達到土耳其人口的95 ％以上。該計劃現在提供高水平的財政保障與公平，同時確保患者滿意度高且不斷上升。嬰兒死亡率從2003年每千名活產兒死亡28.5名， 2010年下降到每千名活產兒死亡10.1名。孕產婦死亡率從2000年的每10萬活產死亡61人，2010年下降到每10萬活產死亡16.4人。土耳其的案例證明，財政拮據甚至重大的金融危機都可能促進健康覆蓋面擴大。世行集團一直很高興與土耳其政府合作支持這一努力。
Thailand has focused on strengthening its health workforce, with the Thai Network of Rural Doctors leading the push for reforms. In addition to increasing the number of doctors and nurses, the government raised basic salaries and introduced incentives to attract and retain health workers. As a result of the health workforce scale-up and other factors, popular utilization of essential health services has improved. Since the Universal Coverage Scheme was introduced there has been a declining trend in the incidence of catastrophic health expenditures, defined as out-of-pocket payments for health care exceeding 10 percent of total household consumption expenditure. The incidence dropped from 6.8 percent in 1996 to 2.8 percent in 2008 among the poorest people in the program. The impact on province-specific incidence of impoverishment has been even more impressive: in the poorest rural northeast region of Thailand, the number of impoverished households dropped from 3.4 percent in 1996 to less than 1.3 percent in 2006-2009.
泰國一直專注于加強衛生隊伍建設，以泰國鄉村醫生網絡為首推進改革。除了增加醫護人員人數外，政府提高了基本工資，并推出優惠措施吸引和留住衛生工作者。由于衛生人力資源規模化及其他因素的影響，民眾對基本衛生服務的使用率得到提高。自實行全民健康覆蓋計劃以來，災難性衛生支出——即自付醫療費用超過家庭總消費支出的10％——的發生率呈下降趨勢，在計劃覆蓋的最貧困人口中從1996年的6.8 ％到2008年降低到2.8％。對分省的致貧率的影響更為顯著：在泰國最貧窮的東北農村地區，因病致貧的家庭比例從1996年的3.4％在2006-2009年期間下降到1.3％以下。
Ethiopia launched its Health Extension Program in 2003 to promote universal coverage of primary care. The program delivers 16 clearly defined packages of health services for free. At the center of the program is the network of health extension workers – all women, 10th grade high school graduates recruited from their communities, trained for one year and redeployed back into their communities. More than 35,000 health extension workers have been trained and deployed thus far, and their services are now in high demand from other sectors as well – such as adult literacy or sharing of sustainable agriculture techniques. The challenge is to continue to enhance the skills and performance of these frontline workers and to protect their time to ensure they can provide communities with the quality health services they need. The latest Ethiopia Demographic and Health Survey data show that between 2005 and 2010, child mortality fell from 123 per thousand to 88 per thousand, a 28 percent decline. Over the same time period, Ethiopia also reports impressive reductions in both stunting among children and anemia among women; and contraceptive use nearly doubled, contributing to a reduction in total fertility rate.
埃塞俄比亞在2003年推出健康推廣計劃以促進初級衛生保健服務的普遍覆蓋。該計劃免費提供16項明確規定的醫療服務包。該方案的核心是建立衛生保健推廣工作者網絡——均為女性，從社區招募的 10年級高中畢業生，經過一年培訓，然后重新安置回到社區。截至目前共培訓和安置衛生保健工作者35,000多人。現在其他部門對他們的服務需求也很大，比如成人掃盲或推廣可持續農業技術。目前的挑戰是如何繼續提高這些一線工作者的技能和績效，保障他們的時間，以確保能為社區提供所需要的優質醫療保健服務。最新埃塞俄比亞人口與健康調查數據顯示， 從2005年至2010年期間，兒童死亡率下降了28％ 。在同一時段，埃塞俄比亞的兒童發育不良率和婦女貧血率也出現顯著下降；避孕藥具使用率增加了近一倍，導致總生育率呈現下降。
And in Peru, the government is leveraging its sovereign wealth funds to jumpstart ambitious reforms aimed at realizing universal health coverage. The Bank Group is partnering with the Ministry of Health to develop a national set of indicators that will allow them to measure, monitor, and evaluate the expansion of coverage, and take into account the epidemiological transition that the country is facing.
秘魯政府正在利用主權財富基金推動以實現全民健康覆蓋為目標的雄心勃勃的改革。世行集團正在與衛生部合作制定一套國家指標，用于衡量、監測和評價覆蓋面擴大進度，也考慮到該國所面臨的流行病學轉型的情況。
